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J Pediatr. 2019 Apr 13. pii: S0022-3476(19)30266-5. doi: 10.1016/j.jpeds.2019.02.034. [Epub ahead of print]

Virtual Reality for Pediatric Needle Procedural Pain: Two Randomized Clinical Trials.

Author information

1
General Pediatrics, Monash Children's Hospital, Clayton, Victoria, Australia; General Medicine, Royal Children's Hospital, Parkville, Victoria, Australia.
2
School of Clinical Sciences, Monash University and Monash Health, Clayton, Victoria, Australia.
3
Pediatric Emergency Department, Monash Medical Centre, Clayton, Victoria, Australia.
4
Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia.
5
Anaesthesia and Pain Management Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
6
School of Psychology, Centre for Social and Early Emotional Development, Faculty of Health, Deakin University, Geelong, Victoria, Australia.
7
Emergency Department, Royal Children's Hospital, Parkville, Victoria, Australia.
8
Emergency Department, Royal Children's Hospital, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia.
9
Pain Management, Monash Children's Hospital, Clayton, Victoria, Australia.
10
School of Clinical Sciences, Monash University and Monash Health, Clayton, Victoria, Australia; Pediatric Emergency Department, Monash Medical Centre, Clayton, Victoria, Australia.
11
DataConnect, Melbourne, Victoria, Australia.
12
School of Clinical Sciences, Monash University and Monash Health, Clayton, Victoria, Australia; Monash Lung & Sleep, Monash Medical Centre, Clayton, Victoria, Australia. Electronic address: paul.leong@monash.edu.

Abstract

OBJECTIVE:

To assess the efficacy and safety of a virtual reality distraction for needle pain in 2 common hospital settings: the emergency department (ED) and outpatient pathology (ie, outpatient laboratory). The control was standard of care (SOC) practice.

STUDY DESIGN:

In 2 clinical trials, we randomized children aged 4-11 years undergoing venous needle procedures to virtual reality or SOC at 2 tertiary Australian hospitals. In the first study, we enrolled children in the ED requiring intravenous cannulation or venipuncture. In the second, we enrolled children in outpatient pathology requiring venipuncture. In the ED, 64 children were assigned to virtual reality and 59 to SOC. In pathology, 63 children were assigned to virtual reality and 68 to SOC; 2 children withdrew assent in the SOC arm, leaving 66. The primary endpoint was change from baseline pain between virtual reality and SOC on child-rated Faces Pain Scale-Revised.

RESULTS:

In the ED, there was no change in pain from baseline with SOC, whereas virtual reality produced a significant reduction in pain (between-group difference, -1.78; 95% CI, -3.24 to -0.317; P = .018). In pathology, both groups experienced an increase in pain from baseline, but this was significantly less in the virtual reality group (between-group difference, -1.39; 95% CI, -2.68 to -0.11; P = .034). Across both studies, 10 participants experienced minor adverse events, equally distributed between virtual reality/SOC; none required pharmacotherapy.

CONCLUSIONS:

In children aged 4-11 years of age undergoing intravenous cannulation or venipuncture, virtual reality was efficacious in decreasing pain and was safe.

TRIAL REGISTRATION:

Australia and New Zealand Clinical Trial Registry: ACTRN12617000285358p.

KEYWORDS:

anxiety; cannulation; distraction; pain; venipuncture

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